NCG020670_RE Name-Owner Change Confirmation_20220322

Tran, Kieu M
From: Tran, Kieu M
Sent: Tuesday, March 22, 2022 10:02 AM
To: [e-mail]
Subject: Stormwater Permit Name/Owner Change Confirmation for NCG020670
Attachments: NCG020670 NPDES SW Permit Summary Report.pdf
Good morning,
We have processed the Name/Ownership change for this permit. Please review the attached Permit Summary Report
and verify that the new information is accurate. Please let me know if there are any other necessary updates.
Thank you,
Kieu Tran
4
E Q'
Stormwater Program Administrative Assistant o,--D
Office: (919) 707- 3640
Kieu.Tran @ncdenr.gov
North Carolina Department of Environmental Quality
Division of Energy, Mineral, and Land Resources Stormwater Program
512 N. Salisbury Street, Raleigh, NC 27604 (location)
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
Website: http://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed
to third parties

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the following information in our Permit Database for your permit as of 3/22/2022.
Permit Number: NCG020670 Permit Status: Active
Permit Type: Mining Activities Stormwater Discharge COC
Facility Name: Grissett Swamp Mine Inc
Facility Addressl: 10211 Swamp Fox Hwy
Facility Address2:
City, State & Zip: Tabor City, NC 28463
Owner Information Details:
MUST submit a Change of Name/Ownership form to DEMLR to make any changes to this Owner information.
(Click Here for "Change of Name/Ownership"Form)
Owner Name: William E Fuller
Owner Type: Individual Owner Type Group: Individual
*** Legally Responsible for Permit ***
(Responsible corporate officer/principle executive officer or ranking elected official/general partner or proprietor;
or any other person with delegated signatory authority from the legally responsible person.)
Owner Affiliation: William E Fuller Title:
Addressl: 10211 Swamp Fox Hwy
Address2:
City, State & Zip: Tabor City, NC 28463
Work Phone: [phone] Fax:
Email Address:
*** Permit Annual Fee Billing ***
Billing Month: October
Invoice Number Invoice Date Invoice Due Date Invoice Amount Invoice Status
Owner Contact Person(s)
Contact Name Title Address Phone Fax Email
Facility Contact Person(s)
Contact Name Title Address Phone Fax Email
William E Fuller 10211 Swamp Fox Hwy, Tabor City, NC 910-653-4108
28463
Permit Contact Person(s)
Contact Name Title Address Phone Fax Email
3/22/2022 Page 1

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the followinu information in our Permit Database for vour permit as of 3/22/2022.
Permit Billing Contact(s)
Contact Name Title Address Phone Fax Email
William E Fuller 10211 Swamp Fox Hwy, Tabor City, NC 910-653-4108
28463
Person(s) with Delegated Signatory Authority
Type Contact Name Title Address Phone Fax Email
Person(s) with Electronic Signature Authority
Type Contact Name Title Address Phone Fax Email
Outfalls
Outfall #: 1 Outfall Description: ditch
Outfall Lattitude: 34.079720 Outfall Longitude:-78.701110 Represented by Outfall:
Stormwater: 50 % Industrial: 50
Stream Waterbody
Basin Waterbody Name Index Number Classification
Lumber Grissett Swamp (Lake Tabor) 15-17-1-(1) B;Sw
3/22/2022 Page 2